Background

Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) that can be administered topically or parenterally. No side effects have been described associated with topical administration in dogs and cats. This case report describes the occurrence of acute kidney injury (AKI) in three kittens suspected to be secondary to ophthalmic ketorolac 0,5%.

Case Presentation

Three kittens (mixed-breed male cats of 1.5, 2 and 3.5 months, respectively, weight range 580–720 g) presented to the hospital for progressive lethargy and anorexia, after a minimum of three-day treatment of topical ketorolac TID for suspected viral conjunctivitis. At the time of prescription all cats were assessed to have moderate ocular and nasal discharge but otherwise healthy. No bloodwork was performed at that time. On admission all cats were markedly dehydrated and bradycardic. Bloodwork revealed severe azotemia (creatinine 3,2 mg/dL, 3,2 mg/dL and 6,3 mg/dL, respectively), hyperkalemia (potassium 7,8 mEq/dL, 8,8 mEq/dL and 8,3 mEq/dL, respectively) and hyperphosphatemia (phosphorus 9,6 mg/dL cat 1 and 16,8 mg/dL cat 2). Granular casts and isosthenuria were found on urinalysis in two of the three cases.

Abdominal ultrasound was unremarkable in all cases. All kittens required intravenous fluid-therapy, glucose, regular insulin and calcium gluconate to control hyperkalemia. All cats were assessed to be oliguric during the first day of hospitalization, using serial ultrasound measurements, and normalized urine production over the days without any additional treatment aside of fluid-therapy. Azotemia steadily resolved during hospitalization and at day five all cats were fully recovered and discharged uneventfully.

New/Unique Information

To our knowledge, only 0,1% ophthalmic diclofenac has been previously associated with AKI in cats. This is the first report of another topical ophthalmic NSAID as a potential cause of AKI. Although topical ophthalmic treatment limits the absorption of some drugs, a portion may be absorbed through conjunctival mucosa and decrease glomerular filtration rate. All cats became clinically ill during treatment. Although previous bloodwork and urine culture were lacking and a definitive cause of azotemia could not be established, the clinical presentation, findings and resolution suggest a potential renal insult triggered by administration of topical ketorolac. In conclusion, clinicians should be aware of this potential complication following administration of topical ketorolac in kittens.

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